Medical Associates SmartPlan (Cost) 2024 Benefit Details for Plan H5256-001-0 by Medical Associates Clinic Health Plan of Wisconsin
Medical Associates SmartPlan is a 2024 Cost Medicare Advantage plan {with_without_pdp} Part D.
This Medical Associates Clinic Health Plan of Wisconsin option offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
This plan is rated 5.0 (Excellent) stars by CMS making it a top-rated plan.
Plan Basics | |
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Plan ID: | H5256 001 0 |
Plan Type: | Cost |
Plan Year: | 2024 |
Premium: | $136.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Not Included |
Rx Gap Coverage: | No |
Supplemental Benefits: | Vision |
Availability: | See List |
Insured By: | Medical Associates Clinic Health Plan of Wisconsin |
Summary of Benefits |
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Health Plan Cost Sharing
This Medical Associates Clinic Health Plan of Wisconsin Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 |
Specialist: | $0 |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $0 |
Routine foot care: | $0 |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $0 |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $0 |
Urgent care: | $0 |
Ground ambulance: | $0 |
Inpatient hospital coverage: | |
Outpatient hospital coverage: | $0 |
Skilled Nursing Facility: | |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $0 |
Outpatient group therapy visit with a psychiatrist: | $0 |
Inpatient hospital - psychiatric: | |
Outpatient group therapy visit: | $0 |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $0 |
Occupational therapy visit: | $0 |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment (e.g., wheelchairs, oxygen): | $0 |
Prosthetics (e.g., braces, artificial limbs): | $0 |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $0 |
Lab services: | $0 |
Outpatient x-rays: | $0 |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | $0 |
Other Part B drugs (Medicare-covered) | $0 |
Feel free to download our Medical Associates SmartPlan Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Medical Associates Clinic Health Plan of Wisconsin includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Not Covered |
Hearing aids (In-Network) | Not Covered |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Not Covered |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS Rating Marks for 2024
Each year Medicare rates health plans (Part C) and drug plans (Part D) in several major categories based on a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join this Medical Associates Clinic Health Plan of Wisconsin plan.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | Not enough data available |
Drug Plan Customer Service | Plan not required to report measure |
Complaints and Changes in the Drug Plan | Plan not required to report measure |
Member Experience with the Drug Plan | Plan not required to report measure |
Drug Safety and Accuracy of Drug Pricing | Plan not required to report measure |
Here's why this Medicare Advantage Cost plan exceeds most expectations. Staying healthy is the best way to save money on health care, and Medical Associates SmartPlan does a good job keeping its members in top health through preventive care, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions.
Overall, members say their experience with this Medical Associates Clinic Health Plan of Wisconsin Cost plan is excellent. When it comes to complaints and changes in performance, this plan gets the highest marks.
Medical Associates SmartPlan does not offer any additional popular benefits, like dental, vision, or hearing.
This plan has an additional premium of $136.00 dollars per month. The additional cost may be worth it if you fully use the plan's benefits. Medical Associates SmartPlan has an exceptionally low maximum out-of-pocket (MOOP) limit. It's just per year. With a MOOP this low, your out-of-pocket costs for a 5-day stay in the hospital are much lower than Original Medicare. With no annual deductible, members of this health plan have first dollar coverage, which is comforting on a fixed budget.
Plan Availability
Medical Associates SmartPlan (H5256-001-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H5256-005-0: Mercy Cedar Rapids Senior Plan (Cost)
- H5256-002-0: Medical Associates Community Plan (Cost)
- H5256-001-0: Medical Associates SmartPlan (Cost)
- H5256-004-0: Medical Associates Freedom Plan (Cost)
Contact Medical Associates Clinic Health Plan of Wisconsin
Plan Website: | http://www.mahealthplans.com |
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Formulary Information: | http:// |
Pharmacy Information: | Medical Associates Clinic Health Plan of Wisconsin Pharmacy Page |
Prospective Members: | (800)747-8900 |
TTY Users: | (800)735-2942 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Medical Associates Clinic Health Plan of Wisconsin, http://www.mahealthplans.com, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H5256-001-0 Plan Detail Page
The data on this Medical Associates SmartPlan plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Medical Associates Clinic Health Plan of Wisconsin to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Medical Associates Clinic Health Plan of Wisconsin, at (800)747-8900, prior to enrollment.